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Summary
Hospice programs have varied approaches to do-not-resuscitate (DNR) orders, impacting patient care. This review examines hospice experiences with DNR policies and discusses challenges in respecting patient end-of-life wishes.
Area of Science:
- Medical Ethics
- Palliative Care
- Health Policy
Background:
- The Patient Self-Determination Act mandates healthcare providers establish policies for life-prolonging therapy decisions.
- American hospice programs have historically implemented do-not-resuscitate (DNR) policies.
Purpose of the Study:
- To review hospice program experiences with Do-Not-Resuscitate (DNR) orders.
- To highlight the lack of uniformity in hospice care regarding DNR policies.
Main Methods:
- Review of existing hospice program policies and practices concerning DNR orders.
- Discussion of challenges encountered in implementing and respecting DNR orders.
Main Results:
- Significant variation exists among hospice programs regarding the requirement of signed DNR orders for patient admission.
- Some hospices mandate DNR orders, while others exhibit greater flexibility, indicating an unresolved issue in defining appropriate hospice care.
Conclusions:
- The hospice community faces challenges in standardizing care related to DNR orders and end-of-life decision-making.
- Inconsistent application of DNR orders and living wills by emergency responders, such as paramedics, poses a problem.